It’s one of the most important aspects of communicating the intent of the composer. Fur Elise is a great example of how disorienting (and incorrect) it is to begin the piece as if the first two notes are the downbeat. If interpreted and performed as an anacrusis, the true downbeat (the third and fourth sixteenths of the right hand) will properly orient the listener to the triple meter and will avoid causing the 4/8 feel that “changes” to 3/8 in the next bar. In other words, don’t stress the first sixteenth and you’ll have the pulse correctly placed.