Let me ask you this.
How much does it cost just to get a qualified person to come to your house and just do an assessment on your AC. Or a plumber to come out and do an assessment on a plumbing issue.
Now think about what a reasonable cost is for a qualified doctor to come out and give a health assessment.
This is stupid.
First of all, you go to them generally.
Second of all, doctors are cost shared. A typical predominantly outpatient physician can carry a patient panel of 1000-2000 patients depending on the healthcare system. The cost of the doc is basically spread out over 2000 patients. It's not a 1:1 relationship. There are docs that see 40-45 different patients everyday and it's not uncommon to do so though ideal is probably around 20-25 people a day (20 min appointments). Next time you're at the doctor's office, ask your doc how many people they have scheduled that day. Go ahead.
Thirdly the cost of the doctors examination is <1% the cost of healthcare services generally received. A doctor can implant a CRT device (a type of pacemaker) in about an hour and can do 8 in a day or so. The cost of each of those devices alone (not accounting for the costs of the implant) is 30 to 90k depending on the model. That's what the hospital is charged for the device (actually they get them a bit less but not a massive discount less)
The VA however
1) slightly underpays their docs but have great benefits
2) has negotiating power so things they dont make they can seriously negotiate down
3) make a ton of stuff themselves to avoid paying extra to buy it from other people (mostly hospital supplies and the like)
4) concentrate specialities and avoid duplication (for example in the VA there are only 4 heart transplant centers because not everyone VA needs to be doing heart transplants despite there being 50 major big boy VA hospitals country wide) and are generally slow to offer the latest and greatest until that therapy is proven and time tested. In the private sector, large hospitals have a lot of redundancy with services offer because they have to offer everything to compete with each other including a lot of novel but not necessarily highly beneficial therapies.
There's a lot of other stuff the VA does to save money but most of it is vertical integration and cost savings through negotiating power.