I think the most charitable take at this point is he had the release almost ready to go, and he saw how people reacted to the sprite overlay animations with main characters and the heavy reliance on shonen ecchi manga-inspired weebspeak, and is engaging in a somewhat extensive overhaul of the hospital content.
Those two things were the main fault lines in an otherwise impressive rework, IMO. I know a lot of people still like the old setup but I hate stock Koikatsu, and as much as he changed the old characters, the new ones are much more his own style. Also the piston fucking was getting old, and he addressed that by adding more variety with main characters mostly.
If he's not redoing some of the content based on feedback from the first release, then there's probably some other problem that we should be wary of. Personally, I'm not ready to go that far in my assumptions.