Patient-centered care is increasingly at the forefront of health care reform. In surgical specialties, this fact necessitates that benefits outweigh risks and patient values align with surgical goals. The following article will provide information from our group’s work regarding the current status of surgical decision-making, and hopefully will demonstrate the significant need for physician anesthesiologists who are developing and implementing the Perioperative Surgical Home (PSH) model to become involved in these issues. The point of preoperative assessment overseen by the physician anesthesiologist can be leveraged to review these issues and improve patient-centered care by ensuring high-value clinical appropriateness and alignment with patient values and goals. Effective preoperative processes developed within the PSH model can achieve these outcomes and improve the overall value of surgical care through increased and improved perioperative care coordination.