We rely on this to be able to bring updates quickly to our customers when their needs change.
We also found the tooling lacking for our database server.
On the other hand, we don't use ORMs, instead mostly relying on handwritten select queries, with "dumb" insert/updates being handled by library and others by hand. So we normally don't pull more data over the wire than we need.
Then again, I guess we're a bit old fashioned.
I found that if you are 'happy' with the style of lots of stored procs and data lifting on the server side you usually have a decent source delivery system in place. If you do not have that you will fight every step of the way changing the schema and procs as this monolithic glob that no one dares to touch.